Your answers on this questionnaire will help us match your needs with
the dogs in our program. Please print this form and mail to address below.
NAME: ____________________________________________________________
ADDRESS:__________________________________________________________
CITY: _________________________ PROVINCE: ______POSTAL CODE: _______
PHONE:DAY:____________________EVENING_____________________________
EMAIL: _______________________________________
1. Please check your preference: ( ) Male ( ) Female ( ) Either
2. What size do you want your dog to be when fully-grown?
( )70 to 80 lbs. ( ) Over 80 lbs.
3. Do you have a preference for the age of your dog?
( ) Under 1 year ( ) 1 to 2 years ( ) 2 to 4 years
( ) Over 4 years ( ) No preference
4. How many people in the household?__________
If any children, what ages and sexes?_____________
5. Who is is the dog for? ( ) Self ( ) Spouse ( ) Children
6. Have you ever owned a dog before? ( ) Yes ( ) No
If yes, what happened to your previous dog(s)?
Please give a brief history.
______________________________________________________________
______________________________________________________________
______________________________________________________________
7. Why do you want to own a dog? Please state reasons below.
______________________________________________________________
______________________________________________________________
______________________________________________________________
8. Explain the pet policy where you live.
______________________________________________________________
______________________________________________________________
______________________________________________________________
9. Who is home during the day?_______________________________________
10. Do you have a fenced yard? ( ) Yes ( ) No
If no, where will the dog be kept when you are not home?
______________________________________________________________
11. Approximately how many hours a day will your new dog be alone?
Check one.
( ) 3 hours or less
( ) More than 3 hours, but less than 6
( ) More than 6 hours, but less than 12
( ) More than 12 hours, but less than 18
( ) More than 18 hours, but less than 24
12. Where will the dog be during the day?_____________At night?___________
13. When you are away overnight?___________________
14. Who will have primary responsibility for the care of your dog?
______________________________________________________________
15. Have you and your family discussed the pros and cons of
owning a dog?
______________________________________________________________
16. What is your occupation?__________________How long employed?______
17. Name and address of your employer :
______________________________________________________________
18. Do you and your family understand that owning a dog requires
a lot of time energy if the dog is to be properly cared for?
______________________________________________________________
19. Do you and your family understand that a dog requires a 10 to
12 year commitment?
_____________________________________________________________
20. Have you considered the financial cost of dog ownership?
(Food,training lessons, grooming, supplies, veterinary treatments)
______________________________________________________________
21. Are you financially prepared to give your dog the routine
medical care it requires? (Heartworm preventative, annual
booster shots, annual check-up, etc.)
______________________________________________________________
22. Do you intend to keep the dog primarily indoors or outdoors?
(Please explain)
______________________________________________________________
______________________________________________________________
23. Where will the dog sleep at night?
______________________________________________________________
24. What other animals currently live in your household? Please list.
______________________________________________________________
______________________________________________________________
______________________________________________________________
25. Do you have a veterinarian you have used before or plan
to use with your new dog?
( ) No ( ) Yes
If yes, Please provide name/ address/ telephone.
______________________________________________________________
______________________________________________________________
26. How did you find out about our organization?
( ) Web Page (Name ________________________________)
( ) Shelter (Name ________________________________)
( ) Newspaper (Name_________________________________)
( ) Friend (Name_________________________________)
( ) Other (Name_________________________________)
27. Would you consider volunteering for our organization?
( )Yes ( ) No
If yes, in which of the following areas?
( ) Foster care
( ) Grooming and bathing dogs
( ) Transportation of dogs (i.e. picking up from pounds,vets, etc.)
( ) Telephone calling (i.e. screening adoptive homes,
counseling owners,organizing events & volunteers etc.)
( ) Other ________________________________________________
Do you, the undersigned, understand that any mispresentation of yourself
or any untruths in the information wich you have provided herein will invalidate
this adoption agreement and will give us the right to reclaim the dog without
adoption fee and without having to resort to court procedures .
____________________________________ ____________
Signature Date
S.A.B.S.Q.
c/o Marthe Millas
4410 Boul St-Joseph
app. 2
Lachine, Qc
H8T 1R2
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